| NPI | 1669857199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME147409) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57.025765) |
| 207T00000X Neurological Surgery (Licence: IL 125.069700) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2026-01-20 |